Healthcare Provider Details

I. General information

NPI: 1003120676
Provider Name (Legal Business Name): ISHA SAEEDA TAYLOR PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ISHA SAEEDA TAYLOR PA-C

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27480 AROMATIC CT
MORENO VALLEY CA
92555-4760
US

IV. Provider business mailing address

27480 AROMATIC CT
MORENO VALLEY CA
92555-4760
US

V. Phone/Fax

Practice location:
  • Phone: 323-702-2037
  • Fax:
Mailing address:
  • Phone: 323-702-2037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number20810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: